Criteria for Optimum

Functional Occlusion

"Tlli' clinician tile of bilateral contact would aid in the

needs to understand basic orthopedic mandibular movement The
-JPO concept was accepted, and with advances in
dental instrumentatio~ and it carried
or/and's Ii/ustrated Medical Dictionar~! defines over into the field of fixed prosthodontics.))

1) occlude as "to close as to

mandibular teeth into contact with the
the As total restoration of the dentition became
more feasible controversy arose regarding the
teeth in the maxilla "I In dentistry, occlusioll refers of balanced occlusion in the natural
\~
the relationship of the maxil and mandibu­ dentition After much discussion and debate, the
lar teeth when are in functional contact dur­ concept of unilateral eccentric contact was subse­
activity of the mandible The that quently the natural dentition 67 This
3rises is What is the best functional theory suggeste
.11
:::r occlusion of the teeth? This contacts) as well as protrusive contacts, should
~... :
stimulated much discussion and debate, occur only on the anterior teeth It was during this
,ears, several concepts of occlusion have been time that the term was first used The
(it' _~eveloped and have varying degrees of study of has come to be known as
It might be interesting to follow the the exact science of mandibular movement and
of these concepts resultant occlusal contacts. The con­
cept was popular not for use in restoring teeth
but also in attempting to
HISTORY OF THE STUDY OF OCCLUSION eliminate occlusal It was accepted so
that with any other occlusal
of the occlusal relationships configuration were considered to have a malocclu­
made by Edward in 1899,' sion and often were treated because their
=:clusion became a topic of interest and much occlusion did not conform to the criteria
years of modern to be ideal.
and replacement of teeth In the late 1970s the concept of individ­
2came more feasible. The first ualocclusion . This concept centers around
to describe functional occlu­ the health and function of the
"ll was called bellallced OCclHSiof1. This concept and not on any
- ,ocated bilateral and balancing tooth contacts If the structures of the system are
.' ,-,ng all lateral and movements and without pathology, the
::: ~ "nced occlusion was primarily for is considered physiologic and
dentures. with the rationale that this of specific tooth contacts.

95

-
.,.".
96 Functional Allatollllj

Therefore no in the occlusion is indicated

Afte, examiration of m.;merous with a
of occlusal conditions and no apparent
occl~sa;-related the merit of this con­
cept becomes evidert.
The :aci ng derti stry is apparent
when a with the and symptoms of
occlusal-related comes to the dentai
The dentist must determine

inate th

time) \Vhat is the optir,lum func­

tional occlusion)
the study of occlusion so
Fig.5-1 When the mandible is elevated, force is applied tc
have not been sa(sfactorily answered the cranium in three areas: (I and 2) the temporomandibu­
to determine which conditions lar joints and (3j the teeth.
to cause any
examines certain aratomic and
features of the system f\n accu­
mulation of these features wiii represent the for to
functional occlusion. wh:ch. although it . Thus tl~ese areas need:
may not have a h incidence in the to determine the
ulation. ShOl.;ld represent to the clin IC relationst11p that wilt prevent, mini'T1izc
ment Is when ng to either eliminate or eliminate ar.y oreakdown or trauma, The
occlusion-related disorders or restore mu:ilated and teeth wili De exam;ned
dentition.

OPTIMUM ORTHOPEDICALLY
STABLE JOINT POSITION
CR.ITERIAFOR1HE .9PTlMUM

FUNCTIONAl··OCClUSION
The ten" celltric rt'latioll [CRI been used
dentistry for many years ever the year:­ 'H,mr"'"
As discussed, the system IS an l'ad a of definitions.
interrelated system of considered to designate the
bones. I ~eeth and nerves To ~andibie when the
si a discussion of th system difficult stable Ij~~~~i!Rlm"k'

necessary oefore the basic concepts that influence CR as the most retruded
the function and health of al the components can Because this is
beJ nderstood. the I men~s of the
The mandible bone that is at:ached to the . It
skull and It' a muscular
sl irg When the elevator muscles I the masseter. the const;
the medial otemwid, and the temnoral I func­ tior of CO~ dentures l\t the time it
lion, their contraction raises the considered the most reliable reference pc
that contact is made and torce the obtainable ~n an edentu:Clus natient for accurat
skull in three areas: the two recoraing the oetween the mand:­
IIMls) and the teeth I and maxilia and u for contro
(Ptl:H:I',
these muscles have the pabil usa I contact pattern

 Criteria for OptimulII FUI1(/iollat Oa/llsiol1 97

The popula of CR grew and carried over Positional stabll of the jomt however, is not
into the field of fixed useful­ determined the articular disc
ness in fixed nt stabi is determined
both its ity and ~esearch muscles that pull the loint and prevent dis­
studies associated with muscle function location the articular surfaces The directional
Conclusions from tne Ic 'mum
iE\1G) studies that the muscles of mas­
tication function more harmon and with less
when the in C!;: at the time Muscles stabilize joints Therefore each mobile
:hat the teeth are in maximum i nthasa stobielMSI
dental I)' When pursuing most stable
that CR 'Hvlls, the muscles that Dull across the nts must
.'.as a sound More ~ecent be considered The ma muscles that stabil
~r~derstandjng of the biomechanics and ~unction the P,Als are the elevators. The direction the
-: the TM] however, has questioned the retruded on the
ly
t he tern pora I m usc!es have fi bers that
confusing are oriented nevertheless pre,
::-:rcause the definition dom in a
superior These three rruscle groups
ble for joint and
however, the inferior lateral
--:r in tneir most a make contribution
: ~sae Some clinicians' that none of In the postural without any influence
: - -:rse definitions of CR from the occlusal condition, the are sta­
ton and that the bilized muscle tonus of the elevators and the
tioned downward and for'ward on the articular inferior :ateral Dter\20ids The temperal muscles
~:ences. The ng the most
0' the wil continue
- conclusive evidence exists tha: one
than the others
ertheless. in the midst of this controversy
. sts must needed treatment for thei r
::'lts The use stable,
-:~cential to treatment. Therefore:t necessary
·c,mine and evaluate all available mfmmation
to draw intel conclusions on \\-hich
treatment.
establishing the criteria for the optimum
stable joint the anatomic
:: J of the TM) must be exarm ned
described. the articular is
dense fibrous connective tssue de\'Oid
and blood vessels" This ailows it wii'l­
~eavy forces without damage or the induce­
nful stimuli The purpose disc Fig. 5-2 The directional force of che primary elevator
--:c;ate. protect and stabilize ,he In muscles (temporalis o masseter, and medial pterygoid) is to
lar during functional movements seat the condyles in the fossae in a superoanterior posicion,

-
98 Functional Anatoll1Y

position the condyles superiorly in the fossae. The superoanterior is far more orthopedically
masseters and medial pterygoids the acceptable
superoanteriorly. Tonus in the inferior The controversy arises as to whether there an
lateral pterygoids the condyles anteroposterior range in the most superior
against the slopes of the articular tion of the condyle Dawson l6 that there
eminences. not. which that if the condyles move
By way of summary then, the most orthopedi­ either anteriorly or posteriorly from the most supe­
cally stable joint as dictated bv the rior position, they will also move inferiorly This
muscles is when the are located in their may be accurate in the young, healthy but
most superoanterior in the articular fos­ one must realize that not all joints are the same
sae, fully seated and resting against the posterior Posterior force applied to the mandible is resisted
slopes of the articular eminences. This description in the joint the inner horizontal fibers of the
is not however, until the position of the temporomandibular (TM) I
articular discs is considered. rela­ superoposterior of the is there­
tionship is achieved only when the articular discs fore, by definition. a ligamentous position If this
are interposed between the and ligament is tight, little difference may exist among
the articular fossae The of the discs in the the most superior retruded position, the most
joints is influenced by the interart:cular position (ie Dawsons ), and the
pressures, the morphology of the discs them­ superoanterior (MS) position However, if the Tl\l
selves, and the tonus in the lateral ptery­ ligament is loose or elongated an anteroposterior
goid muscles. This last causes the discs to be range of movement can occur while the
rotated on the condyles as far forward as the discal remains in its most position
spaces (determined by interarticular pressure) and The more posterior the force placed on the
the thickness of the border of the discs mandible, the more of the
will allow will occur and the more posterior will be the
The complete definition of the most orthopedi­ condylar . The degree of anteroposterio~
cally stable position therefore is when the
condyles are in their most superoanterior
in the articular fossae. against the
of the articular with the discs properly inter-
The assume this position when
the elevator muscles are activated with no occlusal

,f

influences. This position is therefore considered to

be the most MS position of the mandible
In this MS position, the articular surfaces and
tissues of the joints are
applled
such that forces
the musculature do not create any dam­ (

\~
age When a dried skull is examined, the anterior
and superior roof of the mandibular fossa can be
seen to be quite thick and able to
withstand loading forces. \
ing rest and function, this is both anatom­
Fig.5.3 The most superoanterior position of the condy e
ically and physiologically sound.
(solid line) is musculoskeletally the most stable positic­
The MS position is now described in the Glossary of the joint. However, if the inner horizontal fibers of [C~
of Prostnodontic Terms as CR 2i earlier defi­
nitions 9ll of CR emphasized the most retruded
temporomandibular ligament allow for some posteric­
movement of the condyle, posterior force will displace tr t
position of the condyles, most clinicians have
come to appreciate that seati ng the condvle in the
mandible from this to a more posterior, less stable positic­
(dotted line).The two positions are at the same superior leve
,,­ ,'.~ -,1!"
 Criteria for Optimum FUl1ctiOflal Occ/usioll 99

to the health of the When the dried skull is examined from an

nt appears to permit anatomic the aspect of the
movement from the MS mandibular fossa is seen to be quite thin and
position the health of the not meant for stress This fea­
may be difficult to clinically assess. the fact that the
Studies of the mandibular does not appear to be
demonstrate that in of the joint
5 as discussed in t, liga­
It portion of participate in function.
~ Therefore some exist to act as limiting structures for certain
d movement to the [CP is extended or border nt movements
normal during function In most this move­ the idea of using this bcnder
5t ment is small (I mm or However, if as an um functional
e- occur in the structures of the joint was discussed Such a
is of the TM ligament. joint border relationship would not be considered
ig posterior range of movement can be increased. um for any other nt would this ortho­
5t The clinician should note that the most princi be any different for the TMI')
he and posterior (or retruded) Because it is sometimes clinically difficult to
'M condyle is not a determine the extracapsular and i
or sound (Fig '5-4). [n this condition of the it is advisable not to
\'Ie :)e to the aspect of the force on the mandible when
-ior retrodiscal lamina, and retrodiscal tissues. to locate the 'v1S of the joint The major
he 3ecause th.e retrodiscal tissues are h vascular­ should be on guiding or directing the
"nt 2ed and well sUDDlied with sensory nerve fibers, to their most in
the are not structured to accept the fossae This can be accomplished either a
'jor "rce. Therefore when force is aDDlied to this area, bilateral mandibular ng or by the
-ere is a great for eliciting and/or musculature itself (as discussed in later
:'iusing breakdown. 24 • 28 For the remainder of this text CR will be defined
as the most superoanterior of the
the articular fossae with the discs
[t can thus be seen that CR
are the same. This definition
of CR is becoming
Another concept of mandibular stabil;tyl~ sug­
gests that a different is optimal for the
are described

of the articular eminences iFig '5-5}l\s the

downward and
the disc
bone are d Examination of
dyle
the dried skul; reveals that this area of the
tion
the
articular eminence is quite thick and able to
lrior withstand force. Therefore tbis
i the like the most 5uperoanterior appears
ition l=ig.5·4 Posterior force to the mandible can displace the be anatomically of forces. in
eve!. : : - :yle from the musculoskeletally stable position. fact this a normal orotrusive movement of

CLARK COLLEGE UBkARY

100 Functional Anatomy
Fig. 5-5 Forward movement of the mandible brings the
condyles down the articular eminences. Increased muscle
activity is likely.
the mandible. The major differences between this
position and the 1\1S lie in muscle func­
tion and mandibular stability
To position the condyles downward and forward
on the posterior slopes of the articular eminences,
the inferior lateral pterygoid muscles must con­
tract. This is compatible with a protrusive move­
ment. However, as soon as the elevator muscles
are contracted, the force applied to the condyles
by these muscles is in a superior and slightly ante­
rior direction. This directional force will tend to
drive the condyles to the superoanterior position
as already described (i.e., MS position). If the max­
imum ICP were developed in this more forward
position, a discrepancy would exist between the
most stable occlusal position and the most stable
joint position Therefore in order for the patient
to open and close in the ICP (which is, of course,
necessary to function), the inferior lateral ptery­
goid muscles must maintain a contracted state to
keep the condyles from moving up to the most
superoanterior positions Therefore this position
represents a "muscle-stabilized" position. not an
MS position Assuming that this position would
require more muscle to maintain mandibu­
lar stability is logical Because muscle pain is
the most common complaint of patients with
masticatory disorders, it would not seem favorable
to deveiop an occlusal condition that may actually
increase muscle activity. Therefore it does not
appear that this position is compatible with mus­
cular rest,29 and it cannot be considered the most
physiologic or functional position.
Another concept that has been proposed to
help the dentist locate the most optimal condylar
position is through the use of electrical stimula­
tion and subsequent relaxation of elevator mus­
cles. In this concept the elevator muscles are
electrically pulsed or stimulated at regular inter­
vals in an attempt to produce relaxation. This tech­
nique has been used by physical therapists fOl
years with good success in reducing muscle
tension and pain. Therefore there may be good
rationale to use electrical stimulation to reduce
muscle pain, even though data are scarce (see
Chapter II). The followers of this concept believe
that if this pulsation is done in an upright-head
position, the elevator muscles will continue to
relax until their EMC activity reaches the lowest
level possible, which they describe as rest. This
rest represents the point at which the forces of
gravity pul down on the mandible equal the
elasticity of the muscles and ligaments that sup­
port the mandible (viscoelastic tone) In mos[
cases this means that the mandible is positioned
downward and fOf\vard to the seated superoante­
rior position. The fact that this is the position of
lowest EMC does not mean this is a
reasonable position from which the mandible
should function. /\s discussed in this text. the res~
position (lowest EMC activity) may be found a:
8 to 9 mm of mouth opening. whereas the postura
position is located 2 to 4 mm below the ICP ir
readiness to function 30JI Assuming that the idea
mandibular position is at the lowest point of EMC
is a naive thought and certainly not sut·
stantiated with data. However. followers of thl:,
believe that it is at this position the::
occlusion should be established.
At least three important considerations que~·
tlon the likelihood that this position is an ide~
mandibular pOSition. The first is related to the fa.:'
that this position is almost always found to
downward and forward to the seated
position. jf the teeth are restored in this
 Criteria for Optimum Functional Occlusion 101

3nd the elevator muscles contract. the condyles of reproducible, Because the
!.dl be seated superiorly. leaving only posterior condyles are in a superior border position, a repeat­
:eeth to occlude. The only way the occlusal posi­ able terminal movement can be executed
.. on can be maintained is to maintain the inferior (see Chapter
3~eral pterygoid muscles in a partial state of con­
--action bracing the condyles the posterior
OPTIMUM FUNCTIONAL TOOTH
of the articular eminences. This, of course.
CONTACTS
'e::lresents a "muscle-braced" position and not an
','5 as previously discussed. just described has been consid­
-"nother consideration in a desirable ered in relation to the infl factors of
~. :;'ldibular position by pulsing the elevator mus­ the joint and muscies. As previously discussed. the
• e3 is that this position is almost always found to occlusal contact pattern influences the
an increased vertical dimension. The highest muscular control of mandibular When
that can be by the elevator mus­ closure of the mandible in the MS position creates
:5 at 4 to 6 mm of tooth separation 32 It is at an unstable occlusal condition, the neuromuscular
=iistance that the elevator muscles are most system quickly feeds back muscle
c': =2nt in breaking through food substances, action to locate a mandibular position that will
the teeth into maximum intercuspation at result in a more stable occlusal condition. Therefore
.ertical dimension would cause a great the MS of the joints can be maintained
--:::se of forces to the teeth and periodontal when it is in harmony with a stable occlusal
. _::Jres, increasing the for breakdown. condition. The stable occlusal condition should
~ :~.ird consideration in using this technique is allow for effective functioning while minimizing
~: : ~~ce the muscles are relaxed, the mandibular to any components of the masticatory
can be greatly
influenced by system The clinician should remember that the
:·re the patient's head
musculature is capable of much greater
::::uired maxillary/mandibular
force to the teeth than is necessary for function
=~:ent moves his or her head forward or back Thus it is important to establish an occlusal condi­
~ ~- tilts it to the right or left, the mandibular tion that can heavy forces with a minimal
: : :- will change It would not appear likelihood of and at the same time be
,ype of variation is reliable when restoring effici en t.
The optimum occlusal condition can be deter­
:- er concern with this is that basi­ mined by the following situations
_::::.- individual. whether healthy or with a I. A patient has only the right maxil and
:: ~.ar disorder, will assume an open and for­ mandibular first molars present. As the mouth
==~tion of the mandible following muscle these two teeth provide the only occlusal
Therefore this technique is not helpful for the mandible (Fig. 5-6) Assuming that
patients from normal healthy 40 Ib of force is applied d function. it can
·.'.'hen this occurs, individuals be seen that all this force will be applied to
considered for unnecessary therapy, these two teeth. Because contact is only on the
_. ~',,' 8e quite extensive, right the mandibular position will be
'., -'ary, from an anatomic standpoint one unstable and the forces of occlusion provided
-' ,je that the most superior and anterior by the musculature will likely cause an over­
the condyles resting on ~he discs closure on the left side and a shift in the
slopes of the articular em mandibular position to that side This con·
most orthopedically sound position dition does not the mandibular stabil­
3:e standpoint it also appears that this ity necessary to function effectively
- of the condyles is mal, An addi­ instability) If forces are applied to ~he
.-: is that it also has the teeth and ioints in this situation breakdown to

"~
102 Functional AnatomlJ

the musculature, the bilateral molar contacts

a more stable mandibular
only minimal tooth surfaces accept
the 40 lb of force provided during function, the
additlona I teeth lessen force appl ied
to each tooth (20 lb per tooth) Therefore this
type of occlusal condition provides more
mandibular stability wr,i1e decreasing force
to each tooth
3. A third patient has only the four first molars and
four second premolars present When the mouth
is closed In the .r-AS position, all eight teeth
contact evenly and simultaneously ( 5~8)
The additional teeth provide more stabilization
Fig. 5-6 When only right-side occlusal contacts are present,
activity of the elevator muscles tends to pivot the mandible
of the mandible. The increase in the number of
using the tooth contacts as a fulcrum, The result is an teeth also decreases the Forces to each
increase in joint force to the left temporomandibular joint tooth, thereby potential
(TMJ) and a decreased force to the right TMJ. (The 40 lb of force during function are now
distributed four of teeth, reSUlting in
10 Ib on each tooth I
tre teeth, and supporting structure is a Understanding the of these illustra~
significant risk tions leads to the conclusion that the !lIlr'.!l':~:: "''' If
2. Another patient has only the four first molars occlusal condition during mandibular closure
present. When the mouth is closed, both right \vould be provided even and simultaneous
and left side molars contact lFig. 5-7L This contact of all possible teeth This type of occlusa
occlusal condition is more favorable than the furnishes maximum for the
because wr,en force is applied mandible while minimizing the amount of force

Fig. 5·8 Bilateral occlusal contacts continue to maim2 ~

Fig. 5-7 With bilateral occlusal contacts, stability of the mandibular stability. As the number of occluding tee:­
mandible is achieved. increases, the force to each tooth decreases.
 Criteria for OptimulI1 Frtnctionai Occ/usion 103

::aced on each tooth during function Therefore

~;.,e criteria for optimum functional occlusion
=2\'eloped to this point are described as even and
multaneous contact of all possible teeth when
:~,e mandibular are in their most
peroanterior position, resting against the poste­
slopes of the articular eminences, with the
::scs properly interposed In other words, the MS
~sjtjon of the (ie, CR ) coin~
jes with the maximum ICP of the teeth. This is
~ :nsidered orthopedic stabU
Stating that the teeth must contact evenly and
Fig. 5-9 PERIODONTAL LIGAMENT. Most fibers
is not descriptive enough to
run obliquely from the cementum to the bone, (The width
~2,elop optimum occlusal conditions The exact
of the periodontal ligament has been greatly enlarged for
. ~'~tact pattern of each tooth must be more closely illustrative purposes.)
'.amined so that a precise description of the
.: :::;mum relationship can be derived. To evaluate
s better, the actual direction and amount of
.. "::e applied to each tooth needs to be
=,,,mined.

Direction of Force Placed on Hie Teetft

. ~en studying the supportive structures that sur­
': ,,;nd the teeth, it is possible to make certain
~ servations:
First, osseous tissues do not tolerate pressure
-"::eslG2340 In other words, if force is applied to
:-:e, the tissue will resorb. Because the
:",,,,:h are constantly receiving occlusal a
:,~:odontalligament ( is present between the
" -t of the tooth and the alveolar bone to help
:: :,trol these forces The PDL is of col­
~;:2nous connective tissue fibers that suspend the
'th in the socket. Most of these fibers run
: ='c;uely from the cementum, extending occlusally
'ittach in the alveolus ( 5_9)40 When force
: a::Jplied to the tooth, the fibers support it and Fig. 5-1 0 When cusp tips contact flat suriaces, the result­
sion is created at the alveolar attachment. ant force is directed vertically through the long axes of the
- '2::sure is a force that osseous tissue cannot teeth (arrows), This type of force is accepted well by the
~2Pt, but tension (pulling) actually stimulates periodontal ligament.
: c::eous formation. Therefore the PDL is capable of
.: ~ ,erting a destructive force (pressure) into an
~eptable force (tension). [n a general sense it
be thought of as a natural shock absorber such as the crest of a ridge or the bottom of a
.: ~ :rolling the forces of occlusion on the bone. fossa the resultant force is directed vertically
.:. second observation is how the PDL accepts through its long axis. The fibers of the PDL are
::us directions of occlusal force. When a tooth aligned such that this type of force can be well
, ::;ntacted on a cusp tip or a relatively flat surface accepted and dissipated (Fig. 5-10 I When a tooth

...""""
~
104 Functional Allatomy

The clinician should remember that vertical .t~. t .... ~

forces created tooth contacts are well
the POL. but horizontal forces cannot be ef'ec­
A---l~-- I:J--+- B dissipated ~2 These forces may create
bone responses or even elicit neuromuscular
reflex activity in an attempt to avoid or guard
against incline contacts.
way of summary. then if a tooth is contacted
such that the resultant forces are directed
. the POL is quite efficient
and breakdown is less
in such a manner that
horizontal forces to the
B '.::::1 ,i/fj A
structures. likelihood of pathologic
effects's greater.
The process of directing occlusal forces through
the axis of the tooth is known as axial ioadifW
Axial loading can be achieved two methods
Fig. 5-11 When opposing teeth contact on inclines, the 1 The first method is the
direction of force is not through the long axes of the teeth. tooth contacts on either cusp
Instead. tipping forces are created (arrows) that tend to flat surfaces that are lar to the
cause compression (A) of certain areas of the periodontal axis of the tooth These flat surfaces can be thE:
ligament and elongation (B) of other areas. crests of marginal or the bottoms
With this type of contac: the resu]ta;~-
forces vd] be direcced the long axis
the tooth iFig 5-12. Al
contacted on an incline. however. the resultant 2 The second method (called tripodization) requirf: o
force is not directed its axis. Instead. that each cusp contacti ng an fossa
a horizontal component i incorporated and such :hat it three contac c
tends to cause tipping ( 5-1 II There'ore when the actual cusp tip. When this c
horizontally directed forces are ied to a tooth. the resultant force directed throw::'
many of the fibers of the POL are not properly axis of the tooth ( 12.
al to control them. As the tooth some Both methods eliminate
of the POL are \vhile others are the POL to accept
pulled or elongated Overall. the forces are not ng forces to the bone and essenti2.
dissipated to the bone.: 1
reduce them

J.

A B

Fig. 5-12 Axial loading can be accomplished by (A) cusp tip-to-flat surface contacts or (B)
reciprocal incline contacts (called tripodization).
 Criteria for OptimullI FUllctiollal Oce/usion 105

Amount of Force Placed on the Teeth it is closer the fulcrum to increase the
The criteria for um occlL:sion have now been likelihood of its cracked This demonstrates
First. even and simultaneous contact of that greater forces can be to an oblect as
teeth shoL:ld occur when the mandibu­ its nears the fulcrum The same can be
said of the 5-1 '31 If a hard
nct is to be cracked between the teeth, the mcst
inences desirable is not between the anterior
::econd, each tooth should contact in such teeth but between the teeth, beca use as
:or that the forces of closure are directed the nut is closer to the fulcrum (the
-~e
TMII and the area of the force vectors (tne mas­
aspect that has been left undis­ seter and medial muscles), greater force
~3sed relates to the of the TMI The can be ied to the Dosterior than to the anterior
-'.:1 permits lateral and excursions, teeth ..)(,-;'
-ch allow the teetn to contact during different The however, more Whereas the
of eccentric movements. These lateral excur­ fulcrum of the nutcracker is
1S allow horizontal forces to be to the system is free to move. As a when
-22-C; As alreadv stated, horizontal forces are not forces are to an on the poste­
the su structures and tne rior teeth the mandible ;s of
-"_:omuscular system, yet the of the downward and forward obtam the occlusal rela­
.-~ requires that SOr,le teeth bear the burden of that wiil best the desired task
-:oe forces, Thus several factors This snifting of the
0- be considered wnen identifying which tooth mandibular Additional r,luscle groups
- -2eth can best accept these horizon:al forces such as the inferior and lateral pterygo
--e lever system of the mandible can be com­ and the temporals are then called on to stabil
with a nutcracker When a nut is being the fT~andib!e resulti in a more com
':':- ed it is between the levers of tile nut­ than that of a nutcracker.
:'.2r and force is aPDlied It it is extremelv hard th concept and realizing that

A B

I
Fig. 5·13 The amount of force that can be generated between the teeth depends on the
distance from the temporomandibular joint and the muscle force vectors. Much more force
can be generated on the posterior teeth (A) than on the anterior teeth (B).

~
106 Fundional Anatomy

applied to the teeth can create pathologic changes

lead to an obvious conclusion: The damaging hor­
izontal forces of eccentric movement must be
directed to the anterior teeth, which are positioned
farthest from the fulcrum and the force vectors.
Because the amount of force that can be applied to
the anterior teeth is less than that which can be
applied to the posterior teeth, the likelihood of
A
"
t

breakdown is minimized 4850

When all the anterior teeth are examined. it
becomes apparent that the canines are best suited
l
to accept the horizontal forces that occur during
eccentric movements}' They have the B ~
longest and largest roots and therefore the best
crown/root ratio. They are also surrounded by
dense compact bone. which tolerates the forces
better than does the medullary bone found around
Fig. 5-14 CANINE GUIDANCE. A, Laterotrusiv€
posterior teeth Another advantage of the
movement, a, Clinical appearance.
canines centers on sensory input and the resultant :-c; :" 1: •
effect on the muscles of mastication. Apparently. :~~:

fewer muscles are active when canines contact during laterotrusive movements than are :.....::::r.i.::

during eccentric movements than when posterior cusp-to-lingual cusp contacts (lingual to
teeth contact. 5556 Lower levels of muscular working) ( 5-16, Aj ir~

would decrease forces to the dental and joint The laterotrusive contacts Ieither canine gu i I. cc,··",,"
structures, minimizing pathosis, Therefore when ance or group function] need to provide adequa-c.
the mandible is moved in a right or left laterotru­ guidance to disocclude the teeth on the :'J ~:lil~::.::;;rJ

sive excursion. the maxillary and mandibular side of the arch lmediotrusive or nonworking sic"
canines are appropriate teeth to contact and dissi­ immediately I Fig 5-\6. B) Mediotrusive contac
pate the horizontal forces while disoccluding or
disarticulating the posterior teeth. When this con­
dition exists. the patient is said to have canifle 9l1id­
ance or canine rise ( 5-14).
Many patients' canines, however. are not in the
proper position to accept the horizontal forces
other teeth must contact during eccentric move­ A
ments. The most favorable alternative to canine
guidance is called group fltftction In group function.
several teeth on the working side contact during
the laterotrusive movement. The most desirable
group function consists of the canine, premolars,
and sometimes the mesiobuccal cusp of the first
molar (Fig. 5-15) Any laterotrusive contacts more
posterior than the mesial portion of the first molar B
are not desirable because of the increased amount
of force that can be created as the contact gets
closer to the fulcrum (TM])
The clinician should remember that the buccal Fig. 5-15 GROUP FUNCTION GUIDANCE
cusp-to-buccal cusp contacts are more desirable A, Laterotrusive movement. B, Clinical appearance.

 Criteria for Optill1t11ll Functionai Ocdusioll 107

B
A L

Fig. 5-17 Protrusive movement with anterior gUidance.

B detail in 7.1 What however, is that

L
B mediotrusive contacts should be avoided in devel·
ar optimum fUicctional occlusion.
When the mandible moves forward into protru,
sive contact. horizontal forces ca n
ied to the tee,h /\s with !atera movements,
the anterior teeth can best receive and dissipate
Fig. 5-16 A, Posterior teeth during a laterotrusive move­ these forces.)0 Therefore the
-;:'1t. Contacts can occur between opposing buccal (B) and arterio and not the
y
teeth should contact
- gJalIL) cusps. When group function guidance is desirable. 5-171 The anterior teeth shadid
buccal-to-buccal contacts are used. Lingual-to-lingual contact or to disarticulate the
:: -:aces are not desirable during eccentric movement. contacts appear
B. ::>osterior teeth during a mediotrusive movement. to unfavorable forces to the
- --tactS occur between the lingual cusps of maxillary teeth system because of the amount and direcion of the
: - :he buccal cusps of mandibular teeth.
force that *
Our'ne this discussion it has become evident
teeth fJnction
~~estructive to the system because
::::'lount and direction of the forces trat can closure of the
.;:; to t'le joint and dental structures. * Some accept these forces wei!, I)
5 trat mediotrusive contacts because their the arch is such trat
:;ciled by the neuromuscular system differ­ the force can their axes
rn other of occlusal contact. EMC The anterior teet h.
demonstrate trat all to()th contacts are well in the arches
In other words. the presence
:::ontacts tends to shut down or inhibit
This results from the so axial loading is nearly
in the POL. which when stim' anterior teeth receive occlusal
";cate responses Yet other EMC contacts du closure, there is a great Ilkeiihood
5uggest that the presence of mediotru· that their suooort;ve structures will not be abe
teeth increases muscle forces and wi II be
the increase in muscle common finding in
::Jnstrated. the rationa for its presence tooth support I.
These concepts are discussed in more

13 47.52.57.58 I 47 52 57. 58
108 Functional Anatomy
A '''If.....
B alert feeding
Fig. 5-18 A, Heavy occlusal contacts on the anterior
teeth can occur when posterior tooth support is lost. The
maxillary anterior teeth are not aligned properly to accept
the mandibular closing forces. These contacts often lead to
labial displacement or flaring of the maxillary anterior teeth.
B, Posterior bite collapse. The posterior teeth have been
lost, resulting in flaring of the anterior teeth. The labial flar­
ing has led to increased interdental spacing proximal to the
maxillary lateral incisor.
Anterior unlike posterior teeth. are in
Droper position to accept the forces of eccentric
mandibular movements. Generally. therefore it
may be stated that posterior teeth function most
in stopping the mandible during clo­
sure, whereas anterior teeth function most effec­
ir gu the mandible during eccentric
:llovements. With an appreciation of these roles it
:)ecomes apparent that posterior teeth should
~ontact sl more than anterior teeth
.. hen the teeth are occluded in the lCP This condi­
~ion is described as mutlwlly vratected accilJsion.
Postural Considerations and Functional
Tootfl Contacts
~c ,)iscussed in Chapter 4, the postural of
ncandible is that which is maintained during
of inactivitv. It is generally 2 to mIT:
below the lCP and can be influenced to some
head position. The degree to which it is
affected by head position and the resulting
occlusal contacts must be considered when devel­
oping ar. optimum occlusal condition 6261 In the
'lormal upright head position. as well as the alert
position (head forwa rd approxi matel:,
I the posterior teeth should contact
than the anterior teeth (mutuall"
protected occlusion) If an occlusal condition is
established with the patient reclined in a dental
chair. the mandibular postural position and result­
ant occlusal condition may be slightly posteriori"
oriented \Vhen the patient sits up or assumes the
, any change in the postural
and its effect on occlusal contacts mLiS~
be evaluated If in the upright head or the
alert feeding the patient's mandible
assumes a sl anterior postural position
of the elevator muscles will result in heav,
anterior tooth contacts. When this occurs, the
anterior contacts must be reduced until the poste­
rior teeth again contact more heavily durin{;
normal closure. This concept is called the cmteril"
envelope af f,melior! When this slight ir
mandibular not considered, the resu
ing anterior tooth contacts can lead to thE
development of functional wear patterns on the
anterior teeth This is not true for all patients. bu­
it is difficult to predict which patient will show th!:,
response This is especially important to thi::
restorative dentist who wants to minimize force,
to anterior restorations, such as porcelain crowns
Failure to understand and evaluate this positio:­
can lead to crown fractures.
SUMMARY OF OPTIMUM
FUNCTIONAL OCCLUSION
tJ "'"
On the basis of the concepts presented in th'
a summary of the most favorable func­
tional occlusal conditions can be derived The fc'­
lowing conditions appear to be the least pathogen:
for the greatest number of patients over tr 11'1,
time
When the mouth closes, the
their most superoanterior !\' ­
on the

~~:e articular eminences with the discs properly
~terposed In this position there is even and
;:::multaneous contact of all posterior teeth. The
~.terior teeth also contact but more lightly
~:' an the posterior teeth.
. I tooth contacts provide axial loading of
=:clusal forces
'..:",en the mandible moves into laterotrusive
:: ~sitions, adequate tooth-guided contacts on
::: laterotrusive (working) side are present to
:::3occlude the mediotrusive (nonworking) side
The most desirable guidance is
: -'·.ided by the canines (canine guidance),
en the mandible moves into a protrusive
, ~ sition, adequate tooth-guided contacts on
anterior teeth are present to disocclude all
: ~~erior teeth immediately
,:-:e upright head position and alert feeding
_ : sc:or., posterior tooth contacts are heavier
-- - anterior tooth contacts,
_____________________
;'t':-tnces ~~_.M
-,;·:.15 illustrated medical dictionary, ed 30, Philadelphia,
~ Saunders, p 1298.
'_' ~ ~ HI: Classification of malocclusion, Dem Cosmos
_. ~~::',-264, 1899,
:-,'~; \'1-/: Balanced occlusions, J :1m Dent Assoc 12:
: .. 33, 1925.
_~,;: IL: Physiologic occlusion, J Am Dent Assoc 13:
:,v)3, 1926.
~~ FS: Cast bridgework in functional occlusion. J Am
~_','lY 20:1015·1019.1933
'.,c:r C: Correction of occlusion: disharmony of the
.~"; dentition. N Y Dent J 13:455-463. 1947,
H. Stuart C: Concepts of occlusion, Dent Clin
~'n "iovember:591-601, 1963.
- -- ,'rd SP, Ash MM: Occlusion, ed 3, Philadelphia, 1983.
... :2rs pp 129-136.
_:.'a CO: Current clinical dental terminology, 5t Louis,
: \!osby.
"~.: U Studies in the mobility of the human mandible,
. ;.-n[O! Scand lO(Suppl): 19-27, 1952.
::,c CO: Swenson's complete den tH res, St Louis, 1970,
112.
. ~d SP: Dysfunctional temporomandibular joint and
o pain, J Prostltet Dent 11 :353-362, 1961.
-:- ~d S' Bmxism: a clinical and electromyographic
\m Dent AsSN 62:21-28, 19G1.
" Int1uence of occlusal patterns on movement of the
- :.c'c J Prostltet Dem 12:255-261, 1962
II
Criteria for Optimum FrmclionalOcciusion 109
1.5. Posselt ll: of ('cciusion and re/t,liJiiit,l1ion,
Philadelphia, 1968, FA Davis, p 60.
16. Dawson Pl.: El'aluation, diagnosis and treatment of occlusal
problems, St Louis, 1989. \1osby, pp 28·34.
17. Jankelson B, Swain CW: Physiological aspects of mastica
torv muscle stimulation: the myomonitor, Quime5sence lilt
3:57-62. 1972,
18, Gelb H: Clinical management of IWild, ned? and T\1J paill and
Philadelphia, 1977, Saunders
19. DuBml EL: Sieller's oral anatomy, St Louis, 1980, Mosby,
P 178.
20. Moffet BC: Articular remodeling in the adult human
temporomandibular joint, Am) Anilt 115:119-127,1969,
21. Van B1arcom CW, Campbell SD, Carr AB et al: The glossary
of prostltodontic terms, ed 7. St Louis, 1999, ,\-losb", P 58.
22. Wu CZ. Chou SL. Ash MM: Centric discrepancy associated
with TM disorders in young adults, J Delli Res 69:.'\34-337,
1990.
23. DuBml EL: Sieher'" ora! anatom,o St Louis, 1980, Mosby.
24. lankelson B, Adib F: Effect of variation in manipulation
force on the repetitiveness of centric relations registration:
a computer-based study, I Am Dent Assae 113:59-62, 1987,
25, Isberg A, Isacsson G: Tissue reactions associated with
internal derangement of the temporomandibular joint.
A radiographic, crvomorphologic, and histologic study,
Acta Odontol Scand 44:160-164,1986,
26. Farrar WB, McCarty WL: A clinical outline of temporo­
mandibular joint diagno:;is llnd treatment, Momgomerv, /\Ia,
1983, r-;ormandie Publications,
27, Dolwick MF: Diagnosis and etiology of mtemal demngemenfS
of the temp(lromandibular joint: Presitieni's COIlFerence on tile
Examination, Diagnosis, <lnd ;\janagement of 'Dyj Disorder"
Chicago, 1983. American Dental Association, pp 112-117.
28. Stegenga B, de Bont lG, Boering G: Osteoarthrosis as the
cause of naniomandibular pain and dysfunction: a unif)'­
ing concept, J Oral A,jaxillofilc Surg 47:249-256, 1989.
29. '\1amyama T, r-;ishio K. Kotani :VI, Miyauchi S, Kuroda T:
The effect of changing the maxillomandibular relationship
by a bite plane on the habitual mandibular opening and
closing movement, J Oral Rehabil 11 :455·465, 1984,
30. Rugh ID, Drago C): Vertical dimension: a study of clinical
rest position and jaw muscle activity. I Prosthet Dent
45 :670-675, 1981.
31. Manns A, Zuazola RV, Sirhan mvL Quiroz M, Rocabado .\1:
Relationship between the tonic elevator mandibular activ­
ity and the vertical dimension during the states of vigilance
and hypnosis, Crania 8: 163-1 70, 1990,
32. Manns A, 1'.1iralles R, Santander It Valdivia J: Influence
of the vertical dimension in the treatment of myofascial
pain-dysfunction syndrome, J Proslhet Dent 50: 70()-709.
1983 .
33. Gibbs CH, ,>"1ahan PE, Lundeen He. Brehan K: Occlusal
forces during chewing: influence on biting strength and
food consistency, J Prosrl1er Dem 46:561-567, 198:,
3 .. , Bates IF: l\IasticatOlY function-a review of the liter.llure. IL
Speed of movements of the mandible. rate of and
forces developed in chewing. J Oral Rehal>i12:24'l-256. 1
 Determinants of Occlusal
Morphology
teet(! that s[<ccessfull[J permit efficient mas­
ticatory function is basic to dentistry and survival.'
-,PO
n health the occlusal anatomy of the teeth func­
I ,ions in harmony with the structures controlling
:he movement patterns of the mandible The
..:ctures that determine these patterns are the
-,,~-:Joromandibular joints I,TM]s) and the anterior
-,,:':", During any given movement the unique
- ::::omic relationships of these structures com­
~ -:' to dictate a precise and repeatable pathway
- ~.a!ntain harmony of the occlusal the
- _~:erior teeth must pass close to but must not
: . - :sct their opposing teeth during mandibular
.:':T',ent. Importantly, the clinician should exam­
- - :,sch of these structures carefully and appreci­
, :' .- 2W the anatomic form of each can determine
- -: :::::c1usal morphology necessary to achieve an
_::-:-um occlusal relationship The structures that
mandibular movement are divided into two
_:'3 I; I those that infl uence the movement of the
. ~::,~ior portion of the mandible and (2) those
~-:-"fluence the movement of the anterior por­
- _: the mandible. The TMjs are considered the
.:r controlling factors (PCFs). and the anterior
. ­ are considered the anterior controlling factors
- ~:- '; The posterior teeth are positioned between
::0:' :\\'0 controlling factors and thus can be
::,::i bv both to varying degrees
I "111_ _-
POSTERIOR CONTROLLING FACTORS
(CONDYLAR GUIDANCE)
As the condyle moves out of the centric relation
position, it descends the articular eminence
of the mandibular fossa. The rate at which it moves
inferiorly as the mandible is being protruded
depends on the steepness of the articular emi­
nence. If the surface is quite steep. the condyle will
take a steep. vertically inclined path If it flatter.
the will take a path that is less vertically
inclined The at which the condyle moves
away from a horizontal reference plane is referred
to as the condylar guidance angle.
Generally, the condylar guidance angle gener­
ated bv the orbitin2 condyle when the mandible
than when the mandible
protrudes straightforward This is because the
medial wall of the mandibular fossa is generally
steeper than the articular eminence of the fossa
directly anterior to the condyle
The two TMJs provide the guidance for the pos­
terior of the mandible and are
responsible for determining the character of
mandibular movement posteriorly They have
therefore been referred to as the PCFs of tfte
mandibttiC!r movement. The condylar guidance is con­
sidered to be a fixed factor because it is unaJter­
able in the healthv patient. It can be altered,
III
- ­
 I 12 FUilctiolwl Ana/omy

however, under certain conditions (trauma.

The relationship of a tooth to the con­
or a surgical procedure)
trolling factors influences the D;ecise movement c:
that tooth, This means that the nearer a tooth is L:
the TM!. the more the nt anatomy will influenc~
ANTERIOR CONTROLLING FACTORS its eccentric movement and the less the anatorr
(ANTERIOR GUIDANCE) of the anterior teeth will influence its movemel-:
Likewise. the nearer a tooth is to the ante~
lust the TMls determine or control the manner rior teeth. the more the anatomy of the anteri,'
in which the posterior portion of the mandible teeth will influence its movement and the less t;"~
moves, the anterior teeth determi how the anatomy of the TMls will influence that mover::er:
The occlusal surfaces of teeth consj~-
or laterally the incisal of a series of cusps with both vertical and horize
mandibular teeth occlude with the tal dimensions. are made up of com
of t he maxi I iary anterior The steepness of ridges that vary in steepness (vertical dimensic­
these lingual surfaces determines the amount of and direction (horizontal dimension)
vertical movement of the mandible. It the surfaces Mandibular movement has both a vertical an,~
are quite steep the anterior aspect of the mandible horizontal component and it is the relations!­
will take a steep-incline If the anterior teeth between these com ponents or the ratio that
have little vertical will provide little in the of mandibular moveme'-­
vertical guidance during mandibular movement. The vertical component is a function of the sur=~
The anterior gUidance is considered to be a oinferior movement. and the horizontal com::
variable rather than a fixed factor It can be altered nent a function of the anteroposterior moveme'-­
by denta I proced u res sLlch as restorations, ortho­ If a condyle moves downward two units as it IllC. C'
dontia. and extractions. It can also be a:te;ed by forvvard two units. it moves away from a horiZOI-­
pathologic conditions such as caries, habits and reference an of 4S degrees I' "~i""';:-;::~ _,'
tooth wear, moves downward two units and forward one
it from this plane at an ang
64 The angle of devia­
UNDERSTANDING THE CONTROLLING horizontal reference plane is what
FACTORS ill mandibular movement
the mandible as it me
To understand the infl of mandibular move­ horizontal plane and zero unite
ment on the occlusal of posterior resulting in a deviation
teeth, one must consider the factors that influence from horizontal of 0 degrees Fig 6-2 shows
mandibular movement. As discussed in Chapter 4. mandible four units in the horizonta;
mandibular movement is determined by the four units in the vertical plane. The result here
anatomic characteristics both of the TMJs posteri­ deviation away from horizontal of 4'5
and of the anterior teeth anterioriy Variations In 6-3 the mandible moves four units ir
in the anatomv of the TMls and the anterior teeth horizontal plane, but in the vertical the
in the movement pattern of moves four units and the l'\CF moves six units
If the criteria fOe optimum functional resUlts in a movement of the rCF
occlusion to be fulfilled the morphologic char­ movement of the ACE Points bet\,.
acteristics of tooth must be in har­ the factors will deviate by different amounts
mony with those of its opposing tooth or teeth plane depending on the:r I!,;'
during II tric mandibular movements, factor The nearer a is to the
Therefore the exact morphology of the tooth the more its movement will appr:
influenced the it travels (because of the greater influenCe: +1111
ng tooth or teeth the PCF on its movement) Likewise the

.'

 Determinants of Occlusal Morphology 113

PCF 4 units forward

o units downward
Units of - - ~ ___
vertical
HRP
movement

HRP ACF 4 units forward

o units downward
:--­ Units of
vertical movement --=:___
J
iTI'n i I ! I
~ Units of ~
horizontal movement

Fig. 6-1 Horizontal reference plane (HRP) of the mandible at both the posterior (PCF)
and the anterior (ACF) controlling factor. The mandible moves horizontally four units from a
position marked by the dotted line. No vertical movement occurs. The solid line represents
the position of the mandible after the movement has taken place.

::lCF 4 units forward

o units downward Fig. 6·2 Movement of the mandible
four units horizontally and four units
vertically at both the posterior (PCF)
HRP and the anterior (ACF) controlling
factor. When the mandible moves
four units down. it moves four units
forward at the same time. The net
result is that it is at a 45-degree angle
from the horizontal reference planes.
Because both the PCFs and the ACFs
HRP ACF 4 units forward
are causing the mandible to move at
o units downward the same rate. each point on the
45° mandible is at a 45-degree angle from
the horizontal reference plane at the
ITU
end of a mandibular excursion.

the ACF the more its movement wiil one that 259c closer to the ACF than to the PCF
.~ 57 (because of the greater :nflu­ will move away from horizontal at an of
.-\CF on its movement I. A 54 (one fourth of the way between 57 a:'d
the factors will move a'way from 45 i
of To examine the influence of any anatomic varia­
tion on the movement pattern of the mandible.
114 FUI1cti011lli Al1alolH!J

PCF 4 units forward

o units downward
HRP

HRP ACF 4 units forward

x y
" _R;~"do""wacd
~
•••••••••••••••• ' \ } •••••••••••••••• ~ •••••••••••• - . I I
_~r' 54' ==' I

Fig.6-3 RESULTANT MOVEMENT OFTHE MANDIBLE WHEN THE CON­

TROLLING FACTORS ARE NOT IDENTICAL. The posterior controlling factor (PCF)
causes the posterior portion of the mandible to move four units forward (horizontally) and four units
downward (vertically). However, the anterior controlling factor (ACF) causes the anterior portion of
the mandible to move four units forward and six units downward. Therefore the posterior portion
of the mandible is moving away from the reference plane at a 45-degree angle, and the anterior por­
tion is moving away at a 57-degree angle. A point (x) that is equidistant from the controlling factors
---,.
will move at a 51-degree angle from the reference plane. Another point (y) that is one fourth closer
to the ACF than to the PCF will move at a 54-degree angle. Thus it can be seen that the nearer the
point is to a controlling factor, the more its movement is influenced by the factor.

_ necessary to control all factors except the one distance it extends into the depth of an
ng examined Remember that the fossa are determined three factors
the anterior and guidances lies in how I. The ACF of mandibular movement (ie anter,:'
,ill,
;nfl uence tooth Because the guidance)
. cclusal surface can be affected in two manners 2. The PCF of mandibular movement (i.e,
and width\. it is to separate the guidance)
~~ructural influence on mandibular movement into 3. The nearness of the cusp to these control:,­
that influence the vertical components and factors
that influence the horizontal components The centric cusps are de\
anatomy of the occlusal surface is also influ­ to disocclude eccentric mandibu
ced by its relationship with the tooth that movements but to contact in the intercuspal pc<
:asses across it during movement. Therefore the tion. For this to occur, they must be enoug~ ,
. cation of the tooth to the center of rotation is contact in the i position but not so Ie .
discussed. that thev contact dunng eccentric movements
""'"
t
EFFECT OF CONDYLAR GUIDANCE
VERTICAL DETERMINANTS
(ANGLE OF THE EMINENCE) ON
OF OCCLUSAL MORPHOLOGY
CUSP HEIGHT
=actors that influence the of cusps and the As the mandible is protruded, the desce:'
of fossae are the vertical determinants 0: the articular eminence. Its descent in rela~
:::c;usal morphologv. The len2th of a cusp and the to a horizontal reference plane is determined

-
'.""''''1 41311.
I,., :"Uiil;;;MMl,1I11l!f"

'·::"!ii\ft~:.."

~---

Deterl11i1wnts of occlusal Morphology I 15

steepness of the eminence. The steeper the emi­ from 8 at a 60-degree

nence, the more the is forced to move in longer cusps. Therefore a steeper of the
as it shifts anteriorly This results in eminence guidance) allows for steeper
sreater vertical movement of the cusps.
:llandible, and mandibular teeth.
In Fig 6-4 the moves away from a hori­
:)ntai reference at a To
EFFECT OF ANTERIOR GUIDANCE
ON CUSP HEIGHT
c mplify visualization, anterior guidance is i Ilus­
--ated at an equal angle The cusp of Anterior guidance is a function of the relationship
.~. ,,'.ill move away from a horizontal reference between the maxillary and mandibular anterior
~- a 45-degree To avoid eccentric contact teeth. As presented in Chapter 3. it consists of the
::2tween premolar A and premolar B in a protrusive vertical and horizontal of the anterior
~- ;::vement, cuspal inclination must be less than teeth To illustrate its influence on mandlbu!ar
movement and thereFore on the occlusal of
in Fig 6-5, and anterior posterior teeth, some combinations of vertical and
~ ::e are presented as bei ng 60 degrees to the hor­ horizontal appear in 6-6.
_. - ntal reference pia nes With these steeper Parts A. B. and C present anterior relationsh
"":Ical premolar A will move away that maintain ecwai amounts of vertical

j')
A cr
Fig. 6-4 A, The posterior and
anterior controlling factors are
the same, causing the mandible to
move away from the reference
plane at a 45-degree angle. B. For
premolar A to be disoccluded
from premolar B during a protru­
sive movement. the cuspal inclines
must be less than 45 degrees,

/'//
/
/

,
I
I
\
\
\
~
,,
\ ' ..... _­
A 8
116 Functional Arlalomy

Fig. 6-5 A, Posterior and ante­

rior controlling factors are identi­
(? U,{<\-W
•
cal and cause the mandible to move
away from the reference plane at a
60-degree angle. B, For premolar
A to be disoccluded from premo­
lar B during a protrusive move­
ment, the cuspal inclines must be
less than 60 degrees. Thus it can B
be seen that steeper posterior
and anterior controlling factors
allow for steeper posterior cusps.

\
\
\

the in horizontal a more vertical component to mandibular me.

one can see that as the horizontal overlap
increases, the anterior decreases
Parts 0, E, and F present anterior
that maintain equal amounts of horizontal
but varying amounts of vertical overlap By com­
the changes in vertical overlap, one can see
that as the vertical overlap increases, the anterior
guidance angle increases.
Because mandibular movement is determined to
a great extent by anterior changes in the
vertical and horizontal overlaps of the anterior teeth
cause changes in the vertical movement patterns of
the mandible. An increase in horizonta:
leads to a decreased anterior
vertical component to mandibular movement, and
flatter posterior cusps. An increase in vertical over­
produces an increased anterior guidance
ment and steeper posterior cusps
EFFECT OF THE PLANE OF
OCCLUSION ON CUSP HEIGHT
The of occlusion is an imaginary line tOL~
ing the incisal edges of the maxillary anterior te",­
and the cusps of the maxillary posterior teeth
of the plane to the angle of the
nence influences the steepness of the cusps. \\
the movement of a mandibular tooth is vie.­
in relation to the plane of occlusion rather t~,
in relation to a horizontal reference plane -­
i nfl uence of the plane of occl usion can be see:­
In Fig 6-7, condylar guidance and anterior
ance are combined to a 45-degree m.
ment of a mandibular tooth when compared
 Determinants of Oalt/sal Morp{lO{ogy I 17

B c

I I

HO

, I
HO

Fig. 6-6 The anterior gUidance angle is altered by variations in the horizontal and vertical

overlap. In A to C the horizontal overlap (HO) varies, whereas the vertical overlap (VO)

remains constant. When the HO increases, the anterior guidance angle decreases. In D to F

the VO varies, whereas the HO remains constant. As VO increases, the anterior guidance

angle increases.

reference plane. However. when the with the of occlusion ( it can oe

~'ovement is compared with one plane hat the movement av/ay from this plane i
_- I it can be seen that the tooth is 60 Therefore the posterior tee:h can have
.. 'i\ from plane at only a ;onger cusps and we have determined that the
- =~, results in the need for flatter poste- plane of occlusion oecomes more nearlv Ilel
0::, that tooth contact wil! be to the angle of the eminence. the
~en the tooth movement is compared must be mace shorter.
I 18 Fun(tional AnatolllY

Fig. 6·7 A, The anterior and poste­

rior controlling factors create a
mandibular movement of 45 degrees
from the horizontal reference plane.
A (J 45°

B, The tooth moves at a 45-degree

angle from the reference plane (HRP).
However. if one plane of occlusion
(POA! is angled. the tooth will move
away from the reference plane at only
25 degrees. Therefore the cusp must
be relatively flat to be disoccluded
.... .... , . POs
during protrusive movement. When ----- .... -
the angle at which the tooth moves
during a protrusive movement is com­
pared with another plane of occlusion
(POs). a much greater discrepancy is
HRP

.. .... -,"
15°
60°

-;- ­
I ----,
evident (45 + 15 = 60 degrees). This
allows for taller and steeper poste­
rior cusps.
81 , V'
25°
- PO;
-. •

of Spee. Given a short radius. the angle at wi­

EFFECT OF THE CURVE OF SPEE
the mandibular teeth move away from the me'
ON CUSP HEIGHT
teeth will be greater than with a radi~,
When viewed from the the curve of Sree is an The orientation of the curve of as dE~~'
curve from the of the mined by the of its radius to a !­
mandibular canine the buccal cusp of will also influence hm\ ­
the mandibular teeth Its curvature can of an individual toot-
be described in terms of the of the radius of 6-10, A the radi us of the
the curve. With a short the curve will be forms a with a constant horizc.
more acute than with a longer radius ( 6-81. reference plane Molars Iwhich are located d 0'

The of curvature of the curve of Spee to the radius I will have shorter cusps. whereas'
influences the height of the cusps that molars (located mesial) will have cusc:
will function in ,;vith mandibular move­ 6- 10. B. the radi us forms a 60-degree d­ :---::::- JF
ment. In Fig. 6-9 the mandible is moving away from ( ..,': ~ . '" S .... !.. T I(
a horizontal reference plane at a 45-degree curve Of more the (, ':.~,:: -E!Ct
Movement away from the maxi teeth more forward with respect to the horizontal p
will vary depending on the curvature of the curve one can see that all the teeth Iprem'
 Determinants of Occlusal Morphology I 19

A B

Fig. 6·8 CURVE OF SPEE. A, A longer radius causes a flatter plane of occlusion. B,
A shorter radius causes a more acute plane of occlusion.

~ B
45°

Fig. 6·9 The mandible is moving away from a horizontal reference plane at a 45-degree
angle. The flatter the plane of occlusion (A), the greater will be the angle at which the
mandibular posterior teeth move away from the maxillary posterior teeth and therefore
the taller the cusp can be.The more acute the plane of occlusion (B), the smaller will be the
angle of the mandibular posterior tooth movement and the flatter the teeth can be.

:S I will have shorter cusps In Fig. 6-10. C. lateral movements ( ca II ed Bennett

line from the constant hori- mOVel11/,fltjDuring a latera excursion the
-:,'",rence plane
rotated (curve moves downward and inward in
c:, - sced more
one can see that the mandibular fossa around axes located in the
:::,:ior teeth
(especially the molars) can ( The of inward
. - ·",r cusps
movement of the orbiting condyle determined
two factors 1.11 of the medial wall
of the mandibular fossa and (2)
~~-::-ECTOF MANDIBULAR LATERAL
of the
--;:'l. 'SLATION
MOVEMENT ON
which attaches to the lateral.
=--_ SP HEIGHT
condyle If the T!v1 I of the
··:Jular lateral translation movement is a is tight and the medial wall is close to the orbiting
::' shift of the mandible that occurs during a pure arcing movement wili be made

. ·-li
120 FUllaiollal Allatomy

•
" ""
A
~

B
~ c
:­

Fig. 6-10 ORIENTATION OFTHE CURVE OF SPEE. A, Radius perpendicu­

lar to a horizontal reference plane. Posterior teeth located distal to the radius will need

shorter cusps than those located mesial to the radius. B, If the plane of occlusion is rotated

more posteriorly. it can be seen that more posterior teeth will be positioned distal to the

perpendicular from the reference plane and can have shorter cusps. C, If the plane is rotated

more anteriorly. it can be seen that more posterior teeth will be positioned mesial to the

perpendicular and can have taller cusps.

around the axis of rotation in the rotating •

\\hen this condition exists, no late:al translation
the rnandiole occurs therefore no mandibu­
r lateral translation movement} I 6-111 Such
condition occurs, Most often :here some
of tne TM I ment, and the medial \\lall
the rnandibclar fossa lies medial to an arc
-:.-.
round the axis of the ! Fig 6-12)
i1en this occurs, the orbiting is moved
to the medial wall and uces a
Tandibuiar lateral translation moven'ent.
The lateral translation movement has three
c,ltributes: amount, timing, and direction The
;;;,0"111 and are determined in part the
~:egree to which the medial wall of the mandibular
../
~"
medially from an arc round the Fig. 6· I I With proximity of the medial wall and a : ,
alsc determined temporomandibular (TM) ligament, there is no lateral t-·­
'ng lation movement.
 Drlenili;wllts of Occ/usal Mor~hology '2'

fr
\\, \
,
'I'.'.'"

1\'1,,\1:
1111

Ii
./
Fig.6·12 When there is distance between the medial wall
-: 11edial pole of the orbiting condyle and the temporo­
-3ndlbular (TM) ligament allows some movement of the
-: :3.ting condyle, a lateral translation movement occurs.
./
Fig. 6·14 The direction of the lateral translation move­
ment is determined by the direction taken by the rotating
condyle. When the rotating condyle follows pathway I.
the central fossa of the teeth will need to be wider than
pathway 2 to disengage the opposing teeth.

~he TM I The more the greater trle lateral translation movement.

. ,:al the wall from the media!
the greater tne amount of latera!
c ~'ation movement ( 6-13) and the looser
~ -\1 ligament attached to the
of the orbit- The dirccticn of latera I translation movement
the direction taKen by the
the bodilY move:nent i Fie. 6-14:
Effect of tfle AmoUtlt of Lateral Translation
Movement on Cusp Height
As iust stated the amount Of latera! translation
movement determined the tightness of the
inner horizontal
attached to the rotating
to \,l/hich ;:he medial wall of the :nanciibu1ar
from the :ned:al of the
and the greater
the greater the amoum mandibu­
lar translation movement .As tile lateral transla,
tion movement increases, the shift of the
mandible dictates that the cusps be
shorter;:o perr.lit lateral translation \vithout creat,
con~act between the maxil and :nandibular
teeth ( 6-151

./ Effect of the Direction of the Lateral Translation

=g_ 6·13 The more medial the medial wall is from the Movement on Cusp Height
. : - e. the greater will be the lateral translation movement. The direction of shift of the du
-. '=:ore when the medial walt is in position 3, It witl allow a iateral translation movement is determined
.'~ ateral translation of the mandible than in position I. the fl'orDholoev and iJea:ner'tou5 attachments of
122 Functional Analolll/j

1
2
3 -

,./
,./
Fig. 6-15 The greater the lateral translation movement, -'i :- :: 'T
Fig.6·17 The more superior the lateral translation move­
the shorter is rhe posterior cusp. Pathway 3 will require
ment of the rotating condyle (I), the shorter the posterior
.....r.-- ::,"'- ,.
shorter cusps chan pathway I.
cusp. The more inferior the lateral translation movemen:
(3), the taller the cusp.
the I'M joint ng rotation The movemen'
occurs within a (or less) cone. the apex
of wh ich is located at the aXIs of rotation ( 6-16)
Therefore in addition lateral movement, the as a determinant of cusp
may also move in (I) a superior is the vertical movement of
( ) an inferior. (3) an anterior, or (4) a a lateral translation mo'. e:
direction. comb:nations of these can
occur. In other words, shifts movement of :­ c.
and so on re shorter
lateral movement; likewise
lateroinferior movement will p05~
rior cusps than will a straight lateral movement

Effect of the Timing of the Lateral Translation

Movement on Cusp Height
of the lateral translation movement
function of the medial wall to the orb:
and the attachment of the TM I
to the These two condit
determine when this movement occurs durj!'
'ateral excursion. Of the three attributes
ateral translation movement (amount, direc
and timing)' the last has the greatest influenc:­
the occl usa I of the te c
,./
If the tim:ng occurs late and the maxillar)
n"Landibular cusps are functional range
Fig. 6·16 The rotating condyle is capable of moving larer­ amount and direction of the lateral transl,,'
ally within the area of a 60-degree cone during lateral trans­ movement will have I if any, influenCe:
lation movement. occiusal morohol02v f-Iowever. if the timing C
 Determinal1ts of Oce/usal Morphology 123

yi CJ?
~\ ).
.., (

'~Al ;/
\

./

Fig. 6·18 TIMING OF THE LATERAL TRANS·
LATION MOVEMENT. /, Immediate lateral transla­
: :on movement (immediate side shift): 2, progressive lateral
:-~nslation movement (progressive side shift). The more
-1iediate the lateral translation, the shorter the posterior
:_sp.
Fig. 6·19 The pathway that the cusp of a tooth follows in
passing over the opposing tooth is a factor of its distance
(radius) from the rotating condyle. Mediotrusive pathway
(A) and laterotrusive pathway (B).

- .ement occurs in the laterotrusive move- ng tooth. Each

the amount and direction of the lateral tion of the arc formed

i :ation movement will

Jsal
.r:e'1 the lateral translation movement occurs
influence the rotating condvle (
be
on the relationship of the
a shift is seen even before the ns to certain anatomic structures.
:-;,nslate from the fossa This is ca:ied an imil1e­
':lieral translation movemf'flt or irnmedwte side
6-18). If it occurs in with eccen­
EFFECT OF DISTANCE FROM THE
~:ovement, the movement is known as a pro­
ROTATING CONDYLE ON RIDGE
_,' latera! tra 115/,1 ti011 mOVP111e11t or side
AND GROOVE DIRECTION
-'le more immediate the side shift the shorter Because the of a tooth varies in relation
i'sterior teeth. to the axis ot rotation of the mandible li.e. rotat­
ing variation \dl occur in the
the laterotrusive and mediotrusive
HORIZONTAL DETERMINANTS The greater the distance of the tooth
OF OCCLUSAL MORPHOLOGY from the axis of rotation i I. the
wider the formed the laterotrusive and
- - _ital determinants of ocC:usal 6-20i. This is consis­
relationships that influence the direction of tent regarcJless of whether maxil or mandibular
3'ld grooves on the occlusal surfaces. Because the are
oetween and over grooves increased in size as the distance from the rotating
--c movements. the horizontal determinants is increased because the ma'1dibular
: uence the of cusps.
_. centric cusp generates both lat­ are
~·.e and mediotrusive oathwavs across more distally [see Fig 6-20. BI
 124 FWlCtionaf Anatomy

EFFEC
ROTAT
THE .\1
~'D G

A B
B

Fig. 6-20 The greater the distance of the tooth from the rotating condyle, the wider the

angle formed by the laterotrusive and mediotrusive pathways. This is true for both mandibu­ ~,

lar (A) and maxillary (8) teeth. A, Mediotrusive pathway; B, laterotrusive pathway.

EFFECT OF DISTANCE FROM THE pathways generated on the tooth by an

MIDSAGITTAL PLANE ON RIDGE centric cusp l\s the tooth is positioned farthe'
AND GROOVE DIRECTION from the midsagittal plane the angles formed
The relationship of a tooth to the midsagittal plane the laterotrusive and mediotrusive pathways \\
will also influence the laterotrusive and mediotrusive increase \ 6-21 )

Midsagittal Midsagittal y~
plane plane

!1B=-=
~
A B 'I~ =-a::

Fig. 6-21 The greater the distance of the tooth from the midsagittal plane, the wider ::111!11;r:1,9~" <~

the angle formed by the laterotrusive and mediotrusive pathways. This is true for both
(A) mandibular and (8) maxillary teeth. A, Mediotrusive pathway; B, laterotrusive pathway.

... .1 "'-'­
 Dftennil1allts of Occ/usal MorpflO/oqU 125

t?
EFFECT OF DISTANCE FROM THE
ROTATING CONDYLES AND FROM Midsagittal
THE MIDSAGITTAL PLANE ON RIDGE plane
AND GROOVE DIRECTION
has been demonstrated that a tooths position in
:elation to the rotating condyle and ~he midsagit­
:31 plane influences the laterotrusive and medio­
:-usive pathways The combination of the two
!J B

=:)sitional relationships is what determines the

e:\act pathways of the centric cusp Positioning
--.e tooth a greater distance from the rotating
but nearer the midsagittal plane, would
:~lJse the latter determinant to negate the influ­
:e of the former. The angle between the
:;:erotrusive and mediotrusive pathways would be
by teeth in the dental arch at Fig.6.22 The more anterior the tooth in the dental arch,
·'eat distance from both the rotating and the wider the angle formed by the (A) mediotrusive and
'-e midsagittal plane the smallest (B) laterotrusive pathways.
would be generated teeth nearer to both
rotating condyle and the midsagittal plane
3ecause of the curvature of the dental arch, the
can be seen: Generally
as the distance pathways and resuitant angles (Fig 6-24) If the
.. :; tooth from the rotating
increases, its shifts in a lateral and anterior
_ ::::1nce from the midsagittal plane
decreases between the laterotrusive and
- : ... ever, because the distance from the
mediotrusive pathways will decrease on both max­
- :::::Ie increases faster than the illary and mandibular teeth If the condyle shifts
~ :-ease in distance from the midsagittal laterally and posteriorly, the angles eenerated will
the teeth tovvard the anterior region increase,
premolars) will have angles between
~terotrusive and mediotrusive pathways than
EFFECT OF INTERCON DYLAR
teeth located more posteriorly
DISTANCE ON RIDGE AND GROOVE
6·22)
DIRECTION
In considering the influence of the intercondylar
::FFECT OF MANDIBULAR LATERAL
distance on the of laterotrusive and
TRANSLATION MOVEMENT ON RIDGE
mediotrusive it is important to consider
1.." 0 GROOVE DIRECTION how a distance influences
-fjuence of the lateral translation movement the relationship of the tooth to the rotating
~eady been discussed as a vertical determ i- condyle and midsagittal plane As the inter­
.': _ occlusal This movement also condylar distance increases, the distance between
e- ::es the directions of and grooves /\S the and the tooth in a arch
-' :)unt of it increases, the angle between the ration increases. This tends to cause wider
-' -'usive and mediotrusive pathways gener­ between the laterotrus;ve and mediotrusive
- the centric cusp tips increases (Fig 6-23] However, as the distance
::Hrection that the rotating condyle shifts increases, the tooth is placed nearer the midsagit­
.3 lateral translation movement influences relative to the rotating condyle-midsagittal
= :ection of laterotrusive and mediotrusive distance. This tends to decrease the
126 Fwutiollal Al1atoll1~

-j A~
A
JJ B

Fig. 6-23 As the amount of lateral translation movement increases, the angle between the
(A) mediotrusive and (8) laterotrusive pathways generated by the centric cusp tips increases.
This is true for both mandibular (A) and maxillary (B) teeth. -:-~I

I'_~IZ::' ~

rr
A, B1A1 B·
_._ B2 A2 B2
A2
A3
B3
/ '" Ao

.l!jJ,J

A E

B,
B2
B3

~~

Fig. 6-24 Effect of anterolateral and posterolateral translation movement of the rotating
.!~I,.::&o
condyle. The more anterolateral the movement of the rotating condyle. the smaller the angle
formed by the mediotrusive and laterotrusive pathways (Al and Bl).The more posterolateral the
movement of the rotating condyle. the wider the angle formed by the mediotrusive
and laterotrusive pathways (AI and BI)' This is true for both mandibular (A) and maxillary """"':~2
(8) teeth.
'~-;'Ir'

6-251 The latter factor negates the most often minimai and therefore the leas::
~":illll!JnI~~~,
influence of the former to the extent that the net enced of the determinants.
effect of increasing the distance is to A summary of the vertical and horizontal h, IHji~,'II!Qj:r'

between the laterotrusive and minants of occlusal morohologv can be fow"

mediotrusive The decrease. however. is Tab'es 6-1 and 6-2.

.:

 Determinal1ts of O((IL/SIII MorpFlOlo!JY 127

~Al\(-;-V·_A2).
\~i\..:-l\.-~:'~
,\-.~.-Y
' \: i\
\ I \
1\\ 1 \
I
\
\
Fig. 6-25 The greater the intercondylar
distances, the smaller the angle formed by the
\ \ I \ laterotrusive and mediotrusive pathways. The
~ •.. ~ greater the intercondylar distances. the smaller
the angle formed by the laterotrusive and
mediotrusive cusp pathways (AI and 8 1 ), The
smaller the intercondylar distance. the wider
A2
the angle between the laterotrusive and
A,
mediotrusive cusp pathways (A2 and 8 2),

TABLE 6-1

Vertical Determinants of Occlusal Morphology (Cusp Height and Fossa Depth)

Factors Conditions Effects

:: :>ndylar guidance Steeper the guidance Taller the posterior cusps

:'.lcerior guidance Greater the vertical overlap Taller the posterior cusps
Greater the horizontal overlap Shorter the posterior cusps
~ ~ ne of occlusion More parallel the plane to condylar guidance Shorter the posterior cusps
:: J I've of Spee More acute the curve Shorter the most posterior cusps
...::c:eral translation Greater the movement Shorter the posterior cusps
'Tlovement More superior the movement of rotating Shorter the posterior cusps
condyle
Greater t\\e immediate '.>ide '.>\\i1t S\\oner t\\e ?o'.>terior eu'.>?>

TABLE 6-2.

-: rizontal Determinants of Occlusal Morphology (Ridge and Groove Direction)

fM:tors Conditions Effects

- ::::~ce from rotating condyle Greater the distance Wider the angle between laterotrusive and
mediotrusive pathways
_ ':::-ce from midsagittal plane Greater the distance Wider the angle between laterotrusive and
mediotrusive pathways
_::~-:" translation movement Greater the movement Wider the angle between laterotrusive and
mediotrusive pathways
- =-: ::>ndylar distance Greater the distance Smaller the angle between laterotrusive and
mediotrusive pathways
128 FUllctiorwl Ana/oll1t}

lns~ead. studies seem to indicate that the

~~~1](C)NSH1PBETWEEN ANTERIOR the articular eminence is not related to any

AN[)P(C)STE~IOR.CONTR<pLlING occlusal relationshio ' . In other
FACTORS

bave oeen made to demonstrate d'ctating mandibular movemeN. This

correlation between the vertica. and horizontal tant c(wcept because the .ACFs can be influence
of the with tre dental ures . .Alteration 0:
the ,ACFs
lingual concavities of the rraxillary anterior an important
teeth ivertical and horizc'ntal relationshi of disturbances in the
anterior lOne suggests that
consistent with
Cons'deration
ril} toward the PCFs that
movement le.g.
directed
steepness of the
of the eminence and
'RtjerCllCeS
1. Moffett BC: The joint. In Sham

E'
lateral translation movement) This phi

horizontal
that moverrent becomes mere
in articular eminence
editor Complete demure prosthodolllics, New York, 1·'

,\!cGrdw-llilL pp 2J 3-230.
Ricketts R'\I: Variations of the temporornandihular jOiL:
rewaled by cephalometric laminagrarhy, :\m J 0,:'
of
with increase in lateral translationi tr:e 'i
concavities of the maXillary anterior teeth will
:lG:R77-892, 1')50 .
•\nglc IL: ~dctorS in temporom':lIldibular form, Alii I ~:
83.223-234, J ')4S.
If
increase reflect a similar movement characteristic
However, scientific evidence to support a corre­
lation betvveen the .ACFs and rCFs IS -...
.
'hlI!!
..."
.,.
.rje
mn'l'
l

Ie
':;"'5:
.;.~
54 FUIICliolllll Anatomy

Arother type of pain sensation that be expe­ demonstraleo that when

rienced wlen afferent inter:,eurons stimulated ta
is >c Te understand tils condi

tion. tle term must be broken dOWI) nd

raised or increased
condition The in fact mea:-,')
painful s~imul to p:otE~ct
'-';len increased
some I factm. such CO-COl1traction
splinter in the finger .After a Fe'.'! hours the tissue because of simultaneous contraction of antagonis­
round the ;Iter becerres quire sensitive to m groups BeW' recognized this CNS
toucl This primary because the response T
io.... __ ~.. ~ ..
Irhe this conditi,jn is
pain it can lead to muscle pain if it
is present when lhere i Protective co-contraction Imuscle i
of tissues without a local mally in the genera location
A common location for lad to it 1101
Ip Patien~s who I Thus felt in
pain will c~)mmon report that· Itle:r a reflex musclE~
When ,he is ned. no local ina such in
cause can found This is a fai situation muscles of mastication. Tilis condition is not
in of heac; and neck unusual and unfortu fools mallY de:ltists
different from muscles of mastication the
at of the Hmvever. such treatment
the sou rce of the alone cannot resolve the the
symptoms Instead co-contraction
may I for some time i 12 to pail: must De addressed for --
olockade is administered. This clinical feature effec've elimination of the masticat,:;rv n'uscle
cause some confusion du
Until now Iy the effect a Understanding rhe effect on
of svmptoms has consloerecL the muse! for
is true when afferent Interneuron are management
involved. If the ce:ltral effect involves Feat detail in later
efferent interneurons. however. motor n however must
One type of efferent effect use it is vltaily i
the develoome:lt of a localized area hvpersensi­ usc;e pa i n As has
in input can ind
called are discussed i:l I"'ore
detail in Another com effere;~t
sou

Tris condition
of Ilal
ttle ng this condition cal
muscles are activated while the elevator muscles 51',151115 r;;ecel:t stud ies however. feli 1
Clre relaxed In the presence of in however ~;le the that m a r e aCil
CNS to resoond differentlv Stohler< has spasms·' ':-hererore this condltic'i
 Fundional NeuroanatolHij and Phijsiologij of tile Masticatorij System 55
is more called mLiscle The key to determin whether these symp­
This condition can become a diagnostic problem toms are a result of the central effect is
for the clinician because the patient continues to their unilaterality Clinicians should remember
report suffering after the nal source of that central effects do not cross the r:lid­
pain has resolved. line in the trigeminal area. Therefore the ciinical
Because muscle pain is an important clin­ manifestations will be seen only on the side of the
ical problem to understand. the example constant deep pain. In other words. one eye will be
is given to illustrate SOr:le considerations in its red and the other normal. or one nostril may be
management mucus and the other not If the source
of the autonomic were le.g ..
allergy). both eyes would be red and both nostrils
discha rging.
Understanding these central
basic to the management of facial pain
A third molar is extracted, and during the ensuing week a
The role that such conditions play in the diagnosis
;ocalized osteitis (dry socket) develops. This becomes a
source of constant deep pain that, by way of the central
and treatment of temporomandibular disorders is
excitatory effect, produces protective co-contraction discussed in detail in later chapters
I muscle splinting) of the masseter and medial pterygoid

'T1uscle. The patient returns in 5 days complaining of the

Jainful condition. Examination reveals a limited range of
"'1andibular opening, caused not by the infection but by the
secondary muscle response. If the source of the deep pain
s resolved quickly (Le., the local osteitis is eliminated). the
:;rotective co-contraction is resolved and normal mandibu­
?r opening will return. If the source is not quickly resolved.
:-e protracted co-contraction may itself produce pain •
... .,ich then perpetuates the protective co-contraction and
",:s:ablishes a cyclic muscle pain condition. In such a case .
."inating the original source of pain (the osteitis) will not
~ ."inate the muscle pain. Treatment must now be directed
:::ecificaily toward the masticatory muscle pain disorder.
., - ch has become wholly independent of the original source
:: :Jain.
central effects involve the autonomic
- _ '2ns. characteristic manifestations will be
-~~ Because the autonomic system controls the
:::::n and constriction of blood vessels. variation
'cd flow will appear as reddening or blanching
"" involved tissues. Patients may complain of
or a eye. Sometimes the
the eye will redden Even
:::oms may be reported . a stuffy or runny
-~ SOr:le patients may report a
the same side as the pain CI
.,elling is rarely seen in
::~rs. yet this is commonly
patients and may represent
to autonomic effects.
Suggested 'Readin!ls
Hell \VE: Temporomandibular dis(1l'ders; classiflClltioll, dwgrwsis,
lIIanagemenl. ed 3, Chicago, 1990, Year Book MedicaL
Okeson JP: Bell's oraj/Kial pains, I'd 6, Chicago, 2005,
Quintessence.
'References
1. Okeson JP: Bell's orojaci(// pains, ed 6, Chicago. 2005,
Quintessence.
2. Cuyton AC: Texlboo" of mediwl physiolog)" Philadelphia,
1991. Saunders, p 1013.
3. De Laat ;\: Reflexes elicitable in jaw muscles and their role
during jaw function and dysfunction: a review of the Iitcra­
lUre. Part II. Central connections of oro facial afferent tlbers,
Cranio 5:246-253. 1987.
4. Dubner R, Bennett GJ: Spinal and trigeminal mechanisms
of nociception, Artrll1 ReI' Nellrosci 6:381-418, 1983.
5. Sessle Ill: The neurobiology of facial and demal pain:
present knowledge, future directions, J Dent Res 66:962-981.
1987.
6. Hu J\V, Dostrovsky 10, Sessle IlJ: functional properties of
neurons in cat trigeminal subnucleus caudalis (meJulLuy
dorsal horn). I. Responses to oral·facial noxious and
nonnoxious stimuli and projections to thalamus and
subnucleus oralis. I Neurophysiol 45: 1 73~ J 92. 1981.
7. Sessle B): Recent insights into brainstem mechanisms
underlying craniof.Kial pain, IDem Educ 66: 108-11 2. 2002.
8. Lund Jr, Donga R. Widmer CC, Stohler CS: The pajn~
adaptation model: a discussion of the relationship between
 Functional Neuroanatomy
and Physiology of the
Masticatory System

"You wl1not treat [wiess ~IOU neurologic structures and 12) the musc,es. The
wldfrsta ml functioll.·· anatomy and function of each of components
-JPO is reviewed in many instances It
difficult to separate function. With a'l understand­

T
he function of the system is ing of these components, basic neuromuscula r func­
, Discr:minatory contraction of tion can be revie\ved
the various head an,d neck muscles is 'lec­
2ssary to move the mandible
MUSCLES
,;:ffective :unctioning A h neu
:::ont:ol system coordi nates the Motor Ullit
"ctivities of the entire The of the neuromuscular system
rill' of nerves is the rroto r unit. v.,hich consists of a nL;mber of
~2rm l1eUrGI1Hj5CUfar 5&151011 ,A basic un.ders~anding of mUSCle fibers that are innervated ore motor
~he anatomy and function of the neuromuscular neuron. Each neuron with the muscle fiber at
stem is essential to the in,fjuence a motor When the r.euror is activated
-:lat tooth contacts as \'1ell as other conditions, the motor
-:'jV on mandibular movement. amounts of which initiates depOlar­
This chaoter divided into :hree The ization of the muscle fibers. causes
:st section reviews In detail the basic the muscle fibers to shortell or contract.
~'-d fU'lction of the neuromusCl;lar system The The nJmber of muscle fibers in'lervated by one
~::::ond describes the basic aclvities of motor neuron according the fu'lc­
3stication, swal and The third tlon of the motor unit. The fewer the muscle fibers
- Il reviews important concepts and mechanisms per motor 'leu ron, t he more the move­
are necessary to understand orofacia l ment. /\ motor neuron may innervate only
the concepTS in these three sections should two or three rnuscle fibers, as in the cil muscles
enhance the clinicians abll to understand a control the lens of the eye).
~~en,t's comolaint and orov:de effective one motor neuron may innervate ~Ull­
dreds of muscle fibers, in any muscle (e.g.
the rectus femoris in the l.... similar variatio'l
ANATOMY AND FUNCTION OF THE
exists in the number of muscle [ibers per motor
NEUROMUSCULAR SYSTEM
neuron v:ithin the muscles of masticaton The
inferior lateral muscle has a
:~'urposesof discussion, the neuromuscL;lar sys­ low muscle fj ber/motor neu ron ratio: therefore it is
divided Into tViO maior comuonents ( I J the capable the fine adlustments in length needed

25

..

'i
~!ili
:'"
 Functional NeuroanatolllY mid PflysioloflY of the Masticatory System 31

The limbic structures function to control our In most areas the cerebral cortex is about 6 mm
emotional and behavioral activities. Within the th and all it contains an estimated
limbic structures are centers or nuclei that are 50 to 80 billion nerve cell bodies Perhaps a biilion
for speci fic behaviors such as anger. nerve fioers lead away from the cortex. as well as
The limbic structures also control numbers into it. to
fear. or other areas of the cortex. to and from deeper struc­
center apparently exists. tures of the brain. and some al the way to the
on an instinctive level. the individual driven cord
toward behaviors that stimulate the side Different regions of the cerebral cortex have
of the center. These drives are not generaly been identified to have different functions A motor
perceived at a conscious level but more as a basic area is primarily involved with motor
nstinct The instinct will certain function. A sensory area receives somatosensory
behaviors to a conscious level For when input for evaluation. Areas for I senses. such
an individual chronic pain behavior as visual and auditory areas. are also found.
xiiI be oriented toward withdrawal from any stimu­ If one were to again compare the human brain
us that may increase the pain. Often the sufferer with a computer. the cerebral cortex wou:d represent
.'.ill withdraw from life itself. and mood alterations the hard disc drive that stores all information
3uch as depression will occur. It is believed that of memory and motor function. Once one
of the limbic structures interact and should remember that the thalamus keyboard)
associations with the cortex, thereby coor­ is the necessary unit that calls the cortex to function
::i;'ating the conscious cerebral behavioral func­
-ons with the subconscious behavioral functions Sensory Receptors
: the deeper limbic system are neurologlC structures or
from the limbic system leading into organs located in all tissues that proVide
can anyone or all of the information to the CNS way of the afferent
~-any internal bodily functions controlled by the neurons the status of these tissues. As in
Impulses from the limbic system other areas of the body, various types of sensory
into the midbrain and meduila can control receptors are located the tissues that
~ch behavior as wakefulness, excitement make up the masticatory system Specialized sen­
o.-.:J attentiveness. With this basic understanding sory receptors information to the
.. Iimbic function, one can quickly understand the afferent neurons and thus back to the CNS. Some
_. oact it can have on the overall function of the indi­ receptors are specific for discomfort and pain These
::Jal. The limbic system certainly a major role are called Other receptors provide infor­
. :Jain problems, as discussed in later chapters mation regarding the position and movement of the
Cortex. The cerebral cortex represents the mandible and associated oral structures. These are
. _.~er of the cerebrum and is made up called that carry informa­
• -"domi of gray matter. The cerebral cortex is tion regarding the status of the internal organs are
-" portion of the brain most associated referred to as Constant input received
the process, even though it cannot from all of these receptors allows the cortex and
.ide thinking without simultaneous action of brainstem to coordinate action of individual
c'::per structures of the brain The cerebral cortex muscles or muscle groups to create appropriate
- ·-e portion of the brain in which all response in the individual
_ne's memories are stored, and it is also the Like other s, the masticatory system uses
-~~ most responsible for one's abil to four malor types of sensory receptors to mon:tor
~ -.' muscle skills. Researchers still do not know the status of its structures ( 1) the muscle
basic mechanisms which the which are receptor organs found in the
-c'Jral cortex stores either memories or muscle tissues (21 the tendon organs,
. _. Jscle skills. located in the tendons: (3) the pacinian corpuscles

11­